ACA vs. Direct-to-Carrier Health Insurance
The Affordable Care Act (ACA)—often called the Marketplace ("on-exchange")—launched in 2010 and is now the most common way individuals and families buy health coverage. This however, is not the only option, though. You can also purchase plans directly from insurance carriers (“off-exchange”) in most states.
ACA Marketplace (On-Exchange)
ACA plans include essential health benefits, cover pre-existing conditions, and cannot deny you based on health history. Many households qualify for premium tax credits and cost-sharing reductions, which can significantly lower monthly costs and out-of-pocket expenses.
- ✅ Access to income-based subsidies (if eligible)
- Premium tax credits can reduce monthly premium
- Subsidies reduce monthly premiums and sometimes may reduce your deductible & out-of-pocket-maximum
- ✅ Standardized benefits & protections (EHBs, preventive care)
- ✅ Can Enroll during Open Enrollment or during a Special Election Period (SEP)
Direct-to-Carrier (Off-Exchange)
Off-exchange plans are purchased straight from the insurer. Benefits are often similar to ACA plans, but no federal subsidies apply. These can be a fit for households that don’t qualify for subsidies or want carrier-specific networks/benefits not offered on the Marketplace.
- ✅ May offer different networks
- ✅ May offer additional benefits (IE Dental, Vision, etc)
- ✅ May have slight variations to the core benefits vs ACA version
- ✅ Useful for households not eligible for ACA subsidies
- ⚠️ NO cost-sharing reductions
- ⚠️ If Premium Tax credit Eligable, they get applied at end of the year, as a traditional tax credit
Enrollment Windows
Most people enroll during the annual Open Enrollment/Election Period:
- Health Insurance Open Enrollment | November 1st - December 15th
- Medicare Annual Election Period | October 15th - December 7th
- Medicare Advantage Open Enrollment | January 1st - March 31ist
- Moving (New city, zip-code, state, etc)
- Loss of Coverage
- Signifigant change in income +/-
- Marriage or Divorce
- Birth or Adoption of a child
- more...